Modelo de control y vigilancia en sanidad ambiental basados en sistemas de autocontrol

The control of environmental health risks is undergoing significant changes with regard to the way these risks are understood and managed by the public health services. Traditionally, the Health Administration has taken on responsibility for guaranteeing the hygienic-sanitary conditions of installations, establishing control and monitoring systems. Nowadays it is the people in charge of the installations who assess their risks and implement control and monitoring systems, while the Health Administration confines itself to approving and supervising such systems.En el ámbito ambiental el control de los riesgos para la salud está experimentando cambios importantes en lo referente a su concepción y a la forma de gestión de los mismos desde lo servicios de salud pública. Tradicionalmente la Administración Sanitaria ha asumido el papel de garante de las condiciones higiénico-sanitarias de las instalaciones, estableciendo sistemas de control y vigilancia. La tendencia actual es que sean los responsables directos de las instalaciones los que valoren los riesgos de las mismas, establezcan sistemas de control y vigilancia, pasando la Administración Sanitaria a ser el organismo que apruebe y supervise dichos sistemas

Epidemiologia ambiental: possibilidades e desafios

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Poverty, social exclusion, and mental health: the role of the family context in children aged 7–11 years INMA mother‑and‑child cohort study

Mental health problems are common in childhood and tend to be more frequent in populations at risk of poverty or social exclusion (AROPE). The family environment can play a role in reducing the impact of economic hardship on these problems. The aim of this study was to assess the effect of multidimensional poverty on the mental health of children aged 7-11 years and the role of the family environment in two areas of Spain. Participants were 395 and 382 children aged 7 and 11 from Gipuzkoa and Valencia, respectively. Internalizing and externalizing problem scales of the child behaviour checklist (CBCL) were used. AROPE indicators were obtained by questionnaire, and three dimensions of the family context (Organization of the Physical Environment and Social Context, Parental Stress and Conflict, and Parental Profile Fostering Development) were measured through subscales 3, 4 and 5 of the Haezi-Etxadi family assessment scale (7-11) (HEFAS 7-11), respectively. Data were analysed using negative binomial regression and Structural Equation Modelling. AROPE prevalence was 7.1 and 34.5% in Gipuzkoa and Valencia, respectively. In both cohorts, there was a significant increase in internalizing and externalizing problems among participants with a higher AROPE score. However, AROPE did not affect internalizing problems in children from families living in a better physical environment and with social support (Subscale 3). The AROPE effect was jointly mediated by subscales 4 and 5 in 42 and 62% of internalizing and externalizing problems, respectively. Preventing economic inequities by economic compensation policies, improving the neighbourhood and immediate environment around the school, and promoting positive parenting programmes can improve mental health in childhood

Children's exposure assessment of radiofrequency fields: comparison between spot and personal measurements

Radiofrequency (RF) fields are widely used and, while it is still unknown whether children are more vulnerable to this type of exposure, it is essential to explore their level of exposure in order to conduct adequate epidemiological studies. Personal measurements provide individualized information, but they are costly in terms of time and resources, especially in large epidemiological studies. Other approaches, such as estimation of time-weighted averages (TWAs) based on spot measurements could simplify the work.; The aims of this study were to assess RF exposure in the Spanish INMA birth cohort by spot measurements and by personal measurements in the settings where children tend to spend most of their time, i.e., homes, schools and parks; to identify the settings and sources that contribute most to that exposure; and to explore if exposure assessment based on spot measurements is a valid proxy for personal exposure.; When children were 8 years old, spot measurements were conducted in the principal settings of 104 participants: homes (104), schools and their playgrounds (26) and parks (79). At the same time, personal measurements were taken for a subsample of 50 children during 3 days. Exposure assessment based on personal and on spot measurements were compared both in terms of mean exposures and in exposure-dependent categories by means of Bland-Altman plots, Cohen's kappa and McNemar test.; Median exposure levels ranged from 29.73 (in children's bedrooms) to 200.10 μW/m; 2; (in school playgrounds) for spot measurements and were higher outdoors than indoors. Median personal exposure was 52.13 μW/m; 2; and median levels of assessments based on spot measurements ranged from 25.46 to 123.21 μW/m; 2; . Based on spot measurements, the sources that contributed most to the exposure were FM radio, mobile phone downlink and Digital Video Broadcasting-Terrestrial, while indoor and personal sources contributed very little (altogether <20%). Similar distribution was observed with personal measurements. There was a bias proportional to power density between personal measurements and estimates based on spot measurements, with the latter providing higher exposure estimates. Nevertheless, there were no systematic differences between those methodologies when classifying subjects into exposure categories. Personal measurements of total RF exposure showed low to moderate agreement with home and bedroom spot measurements and agreed better, though moderately, with TWA based on spot measurements in the main settings where children spend time (homes, schools and parks; Kappa = 0.46).; Exposure assessment based on spot measurements could be a feasible proxy to rank personal RF exposure in children population, providing that all relevant locations are being measured

Risk of Child Poverty and Social Exclusion in two Spanish Regions: Social and Family Determinants

Objective: Describe the risk of poverty and social exclusion in children aged 8-11 years from Gipuzkoa and Valencia (Spain), through AROPE (At Risk Of Poverty or Social Exclusion) indicators, and evaluate their associated factors in the INMA Project (Childhood and Environment). Method: Families in Gipuzkoa and Valencia (394 and 382, respectively) completed a questionnaire in 2015-2016. Low work intensity (LWI), at risk of poverty (RP) and material deprivation (MD) were estimated. AROPE consisted in meeting any of the previous sub-indicators. Socio-demographic, family and parental characteristics were considered. Frequencies, Venn's diagrams, and chi-square and Fisher tests were used in bivariate analysis and logistic regression in multivariate analysis. Results: For LWI, RP, MD and AROPE, prevalence of 2.5%, 5.6%, 2.3% and 7.2% were obtained in Gipuzkoa, and 8.1%, 31.5%, 7.8% and 34.7% in Valencia, respectively. In the multivariate analysis, the AROPE was associated in both areas with maternal social class and non-nuclear families. In Gipuzkoa, it was also related to maternal education. In Valencia, other factors were the mother's foreign origin, and paternal education and smoking. Conclusion: There is higher AROPE prevalence in Valencia. Social class and family type were shared factors, but a differential pattern is observed in other social determinants. It is essential to implement social policies to reduce this axis of inequalities in health, especially in childhood.This study was funded by Grants from European Union (FP7ENV-201 1 code 282957 and HEALTH.2010.2.4.5-1), Spain: Institute de Salud Carlos 111 (ISCIII) (Red INMA G03/176, CB06/02/0041; FISFEDER: P103/1615, P104/1509, PI04/1112, P104/1931, P105/1079, P105/1052, P106/0867, P106/1213, P107/0314, P109/00090, P109/02647, P111/01007, P111/02591, P111/02038, P113/1944, Pll 3/2032, P11 3/02187, P114/00891, P114/01687, PI16/1288, and PI17/00663), Generalitat Valenciana: Fundacion para el Fomento de la Investigacion Sanitaria y Biomedica de la Comunitat Valenciana (FISABIO) (UGP 15-230, UGP-15-244, and UGP-15-249), Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Piablica (CIBERESP), Department of Health of the Basque Government (2005111093, 2009111069, 2013111089 and 2015111065), and the Provincial Government of Gipuzkoa (DFG06/002, DEG08/001 and DEG15/221) and annual agreements with the municipalities of thc study area (Zumarraga, Urrctxu, Legazpi, Azkoitia y Azpeitia y Beasain)

Perceção do risco de exposição a campos eletromagnéticos de radiofrequência na coorte INMA-Guipúscoa

Perception of environmental risks to the population is a priority issue for the bodies and administrations responsible for managing them. There are few studies on the perception of the risk to RF, but all of them report high levels of concern. This study describes and analyzes the RF risk perception of mothers belonging to the INMA-Gipuzkoa project.Data on perception were collected by means of two questionnaires given to mothers in two different periods. During pregnancy, 625 mothers chose the five relevant environmental issues in their place of residence from a list of 16. When their children were 8, 386 mothers rated, on a scale from 0 to 10, their perception of their levels of exposure to RF and the health risk derived from such exposure.During pregnancy, 31.8 % of mothers chose proximity to RF antennas as one of the 5 most important environmental problems. When their children were 8, 98.0 % and 90.3 % of women reported medium or high perception values (between 5 and 10) regarding exposure and health risk, respectively. A moderate correlation was found between exposure perception and risk perception (0.5). There is no association between RF exposure perception and actual levels measured inside homes.Knowing the factors associated with the perception of risks by the population will be useful to manage them properly.La percepción sobre los riesgos ambientales en la población es un tema prioritario para los organismos y administraciones responsables de su gestión. Los pocos estudios que han evaluado la percepción del riesgo a radiofrecuencias (RF), apuntan a unos niveles altos de preocupación. Este estudio describe y analiza la percepción del riesgo a RF en las mujeres del proyecto INMAGipuzkoa.Los datos sobre percepción se recogieron mediante cuestionarios en dos diferentes periodos. Durante el embarazo 625 madres seleccionaron 5 problemas ambientales relevantes en su lugar de residencia de una lista de 16. A los 8 años de edad de los niños, 386 madres puntuaron, en una escala de 0 a 10, su percepción sobre el nivel de exposición a RF y el riesgo para la salud derivado de esa exposición.Durante el embarazo un 31,8 % de madres eligieron la cercanía a antenas de RF como uno de los 5 problemas ambientales más importantes. A los 8 años de edad de los niños el 98,0 % y el 90,3 % de las mujeres referían niveles de percepción medios o altos (entre 5 y 10) respecto a la exposición y el riesgo para la salud, respectivamente. Se encontró una correlación moderada entre percepción de exposición y de riesgo (0,5). No existe relación entre percepción de la exposición a RF y los niveles reales obtenidos mediante mediciones en las viviendas.Conocer los factores asociados con la percepción de los riesgos por la ciudadanía ayudará a gestionarlos de forma adecuada.A perceção da população sobre os riscos ambientais é um assunto prioritário para os organismos e administrações responsáveis pela sua gestão. Os poucos estudos que avaliaram a perceção do risco de exposição a radiofrequências (RF) indicam níveis altos de preocupação. Este estudo descreve e analisa a perceção de risco de exposição a RF em mulheres do projeto INMA-Guipúscoa.Os dados sobre a perceção foram obtidos através de questionários em dois períodos diferentes. Durante a gravidez 625 mães selecionaram 5 problemas ambientais relevantes no seu local de residência de entre uma lista de 16. Aos 8 anos de idade das crianças, 386 mães pontuaram, numa escala de 0 a 10, a sua perceção sobre o nível de exposição a RF e o risco para a saúde derivado dessa exposição.Durante a gravidez 31.8% das mães elegeram a proximidade a antenas de RF como um dois 5 problemas ambientais mais importantes. Aos 8 anos de idade das crianças 98,0 % e 90,3% das mulheres referiram níveis de perceção médios ou altos (entre 5 e 10) relativos à exposição e ao risco para a saúde, respetivamente. Encontrou-se uma correlação moderada entre a perceção de exposição e de risco (0,5). Não existe uma relação entre a perceção da exposição a RF e os níveis reais obtidos através de medições nas habitações.Conhecer os fatores associados à perceção de risco por parte dos cidadãos ajudará a geri-los de forma adequada

Poverty, social exclusion, and mental health: the role of the family context in children aged 7–11 years INMA mother-and-child cohort study

Mental health problems are common in childhood and tend to be more frequent in populations at risk of poverty or social exclusion (AROPE). The family environment can play a role in reducing the impact of economic hardship on these problems. The aim of this study was to assess the effect of multidimensional poverty on the mental health of children aged 7–11 years and the role of the family environment in two areas of Spain. Participants were 395 and 382 children aged 7 and 11 from Gipuzkoa and Valencia, respectively. Internalizing and externalizing problem scales of the child behaviour checklist (CBCL) were used. AROPE indicators were obtained by questionnaire, and three dimensions of the family context (Organization of the Physical Environment and Social Context, Parental Stress and Conflict, and Parental Profile Fostering Development) were measured through subscales 3, 4 and 5 of the Haezi-Etxadi family assessment scale (7–11) (HEFAS 7–11), respectively. Data were analysed using negative binomial regression and Structural Equation Modelling. AROPE prevalence was 7.1 and 34.5% in Gipuzkoa and Valencia, respectively. In both cohorts, there was a significant increase in internalizing and externalizing problems among participants with a higher AROPE score. However, AROPE did not affect internalizing problems in children from families living in a better physical environment and with social support (Subscale 3). The AROPE effect was jointly mediated by subscales 4 and 5 in 42 and 62% of internalizing and externalizing problems, respectively. Preventing economic inequities by economic compensation policies, improving the neighbourhood and immediate environment around the school, and promoting positive parenting programmes can improve mental health in childhood.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This study was funded by Grants from the European Union (FP7-ENV-2011 code 282957 and HEALTH.2010.2.4.5-1), Spain Instituto de Salud Carlos III (ISCIII) (Red INMA G03/176, CB06/02/0041, FIS-FEDER PI03/1615, PI04/1509, PI04/1112, PI04/1931, PI05/1079, PI05/1052, PI06/0867, PI06/1213, PI07/0314, PI09/00090, PI09/02647, PI11/01007, PI11/02591, PI11/02038, PI13/1944, PI13/2032, PI13/02187, PI14/00891, PI14/01687, PI16/1288, PI17/00663, and PI19/01338), Generalitat Valenciana Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) (UGP 15-230, UGP-15-244, and UGP-15-249), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Department of Health of the Basque Government (2005111093, 2009111069, 2013111089 and 2015111065), and the Provincial Government of Gipuzkoa (DFG06/002, DFG08/001 and DFG15/221) and annual agreements with the municipalities of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia, Azpeitia, and Beasain)

Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study

Objectives: We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages. Design: Population-based cohort study. Setting Spain. Participants We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain. Main outcome measures We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs). Results Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67). Conclusions A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.This study was funded by grants from Instituto de Salud Carlos III and Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021–2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314; 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867; FIS-PS09/00090, FIS-PI042018, FIS-PI09 02311, FIS PI11/01007, FISPI13/02429) Universidad de Oviedo, Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069) and the Provincial Government of Guipuzcoa (DFG06/004 and DFG08/001)

egionelose esporádica: um problema não resolvido

Objective: To summarize the major findings obtained in different studies focusing on the origin of sporadic legionellosis.Methods: A literature search was conducted in national and international journals (1990-June 2012), and those articles that fell within the scope of the study were selected. The articles have been classified into three groups: (i) studies designed to identify environmental risk factors, (ii) studies based on the transmission hypothesis from specific sources, and (iii) studies based on the spatial-temporal pattern of legionellosis.Results: Of the 27 articles selected, half (13) were conducted in the UK or the USA and 2 in Spain. Having a travel history during the incubation period and being a professional driver were the two most frequently identified environmental risk factors. Sources of infection historically related with outbreaks, such as cooling towers and drinking water systems, have also been associated with sporadic cases. The influence of meteorological factors on incidence of the disease has been indicated in a consistent way by various authors, while studies based on spatial analysis methods are gaining in importance.Conclusions: Despite the different hypotheses proposed about the origin of sporadic legionellosis, there is no clear epidemiological evidence regarding the sources of infection. This calls into question if the current monitoring and surveillance measures are sufficiently effective to prevent the occurrence of sporadic cases, and also highlights the need for further research.Objetivo: Resumir los hallazgos más relevantes obtenidos en diferentes estudios dirigidos a investigar el origen de la legionelosis esporádica. Métodos: Se ha realizado una búsqueda bibliográfica en revistas nacionales e internacionales (1990-junio 2012) y se han seleccionado los artículos que se ajustan al objetivo del estudio. Los artículos se han clasificado en tres grupos: (i) estudios dirigidos a identificar factores ambientales de riesgo; (ii) estudios basados en hipótesis de transmisión a partir de fuentes concretas; y (iii) estudios basados en la variabilidad espacio-temporal de la legionelosis. Resultados: De los 27 artículos seleccionados, la mitad (13) se han realizado en Reino Unido o EEUU y 2 en España. Los factores de riesgo ambiental identificados con más frecuencia han sido el historial de viaje durante el período de incubación y ser conductor de profesión. Fuentes de infección relacionadas históricamente con brotes, como las torres de refrigeración y el agua de consumo, también se han asociado con los casos esporádicos. Diferentes autores señalan de forma consistente la influencia de los factores meteorológicos en la incidencia y están adquiriendo importancia los estudios dirigidos a analizar el patrón espacial de presentación de casos. Conclusiones: A pesar de las diferentes hipótesis sobre el origen de la legionelosis esporádica no existe una evidencia epidemiológica clara sobre las fuentes de infección. Se pone en cuestión si las medidas de control y vigilancia realizadas actualmente están siendo suficientemente eficaces para prevenir la aparición de casos esporádicos y se destaca la necesidad de seguir investigando.Objetivo: Resumir as descobertas mais relevantes obtidas em diversos estudos cujo objetivo é investigar a origem da legionelose esporádica.Métodos: Realizou-se uma pesquisa bibliográfica em revistas nacionais e internacionais (1990-jun 2012) e foram selecionados os artigos que se ajustam ao objetivo do estudo. Os artigos foram classificados em três grupos: (i) estudos que visam identificar fatores ambientais de risco; (ii) estudos baseados na hipótese de transmissão a partir de fontes concretas; e (iii) estudos baseados na variabilidade espaço-tempo da legionelose. Resultados: Dos 27 artigos selecionados, a metade (13) foi realizada no Reino Unido ou nos EUA, e 2 em Espanha. Os fatores de risco ambiental identificados com mais frequência foi o historial de viagem durante o período de incubação e ser motorista de profissão. Fontes de infeção relacionadas historicamente com surtos, como as torres de refrigeração e a água de consumo, também se associaram com os casos esporádicos. Diversos autores assinalam de forma consistente a influência dos fatores meteorológicos na incidência e estão a adquirir importância os estudos cujo objetivo é a análise do padrão espacial de apresentação dos casos.Conclusões: Apesar das diversas hipóteses sobre a origem da legionelose esporádica, não existe uma evidência epidemiológica clara sobre as fontes de infeção. Põe-se em questão se as medidas de controlo e vigilância realizadas atualmente estão a ser suficientemente eficazes para prevenir o aparecimento de casos esporádicos e destaca-se a necessidade de continuar a investigar